About a month ago, I noticed behavior changes in my senior dog, Earl. After an impeccable house training record, he began having accidents in the house. He struggled to settle in the evening, often resorting to pacing back and forth. His already anxious personality became even more sensitive to changes in environment and occasional separation from one or more of his humans.

I’m still coming to terms with what this diagnosis means, and what needs to be done to ensure I meet Earl’s journey into this next stage of his life with evidence-based care, training, and enrichment.

This blog is my way of sharing this journey. I’ll be posting personal updates on my days with Earl, our experiences with various supplements, and training and enrichment interventions. For now, please subscribe for future updates, share with friends and colleagues, and check out the continually growing resources page.

Sometimes, we can’t control when our dogs’ wiggles stop. The environment is unpredictable, as are canine cognitive dysfunction symptoms. But we can help bring their wiggles back, ensuring they feel safe, enriched, and happy.

In the months since Earl received his canine cognitive dysfunction diagnosis, his separation anxiety symptoms have increased. He has never liked being left alone; my husband and I have upheld our promise to him since adopting him more than four years ago that we will never leave him alone for longer than he is comfortable. But lately, these separation anxiety symptoms are more intense. His tolerance for my being away from home has decreased, and he’s become more sensitive to me and my husband’s fluctuations in work schedules.

Last weekend, I had a long day at work. Earl wasn’t alone – he was at home with my husband, and had a day full of walks, puzzle toys and snuggles. But it took him about three hours after my return home for him to settle. He paced, panted, and barked. Not even snuggling in bed, his safe space, could calm him. Though he gradually calmed down, he was still exhibiting signs of stress and anxiety throughout the next morning.

It’s never an easy thing to witness your dog exhibiting signs of stress, particularly when the tools you usually use to help your dog calm down and feel better don’t seem to be working. It’s also not easy to realize that these episodes will likely increase in frequency as your dog gets older.

Following a few hours of anxiety on my end the following day, I decided my primary focus for Earl should be helping him getting his “wiggle” back. A friend and training colleague helped me coin the term “wiggle parameter” a few years ago when we were working with her dachsund. When her dog was happy and relaxed, her body was loose, wiggly, and waggy. Regardless of where we were in our training plan, we kept an eye on her dog’s “wiggle parameter” to gauge whether we were moving too fast or whether her dog needed a break from training.

(Bias alert: I’m not one of those trainers who dreams of dogs with perfect “obedience” style behaviors. I want them happy, wagging their tails, and wigging their bodies, feeling joyous and stress-free during their training experiences. If that means they wiggle a bit — or a lot, depending on the size of their tail wag — during a sit-stay, that’s fine by me!)

Returning to Earl, following that stressful evening of hours-long pacing and panting, I made a mental list of things that Earl loves, and called it “The Wiggle List.” Every dog’s wiggle list will be a bit different. Earl’s list includes:

Puzzle toys

Canine fitness work on his FitPaws equipment

Chewing (he only has 6 teeth, but he still loves to chew)

Snuggles in his safe spaces

“Sniffari” walks where he can explore and sniff

The Wiggle List will not only help Earl feel safe, but it will help me have a plan when his CCD symptoms escalate. And if one item doesn’t bring the wiggle back, I can move on to another on the list.

Sometimes, we can’t control when our dogs’ wiggles stop. The environment is unpredictable, as are CCD symptoms. But we can help bring their wiggles back, ensuring they feel safe, enriched, and happy.

Yesterday, I took Earl to our veterinarian for his weekly underwater treadmill workout. I was helping him do some “warm-up” exercises when another client asked me, “What’s wrong with your dog? He looks amazing to me!”

I had to stop and think about my reply. After all, what was wrong with Earl? As it turns out, I didn’t have an answer to that question. I ended up telling the other client that Earl was at the rehab clinic for prevention. The other client told Earl, “You don’t look like you belong at the rehab clinic – you look too healthy!”

Earl has been taking weekly underwater treadmill sessions, along with continuing a series of fitness exercises at home, for over a year now. Our vet jokingly calls him a “super senior” because of his strong muscles and his enthusiasm for anything related to fitness training. And whenever he goes to the rehab clinic, people remark how strong and healthy he looks.

I’ve been thinking about this interaction ever since. It’s so easy to develop narratives for ourselves and our animals. It’s even easier to focus on polaroids of behavior as opposed to looking at the entire roll of film. Since Earl’s treadmill appointment, I’ve been challenging myself to reframe the narrative of Earl being unwell. After all, on paper, he’s a super senior: Strong heart, strong lungs, strong muscles, active brain. On paper, Earl is a healthy dog. Off paper – my recent narrative – Earl has not been a healthy dog. Polaroids include moments of increased separation anxiety, times when he looks confused, one night when he got stuck in a closet, and the nights when he paces back and forth. While these are all symptoms of cognitive decline, and stressful symptoms at that, I’ve been neglecting to view the entire roll of Earl’s film.

Question three is the theme of this post, and the theme of my current narratives with Earl. After yesterday’s interaction at the rehab clinic, I realize I’m not acknowledging Earl’s physical strength. I’m forgetting the benefit his fitness and treadmill exercises bring him. If he gets stuck behind a desk or under a chair, more often than not he can navigate his way out of the obstacle because his muscles are strong enough and flexible enough to do so. I may have to worry about him becoming confused on a walk, but I don’t have to worry about his endurance. (He does 20-25 minutes straight on the underwater treadmill!) And no matter what kind of dementia symptoms he’s experiencing, whenever I pull out the fitness equipment, he wags his tail, jumps around, and immediately starts training and offering behaviors in rapid succession. In fact, doing 5-10 minutes of fitness exercises has been an effective way to help him sleep and interrupt his cycle of anxious pacing.

So a special thanks to that client who spoke with Earl and I yesterday at the rehab clinic for helping me reframe my narrative for Earl’s journey. And a special thanks to Ilana Strubel, Earl’s veterinarian, and Lori Stevens, a training colleague who introduced me to the benefits of canine fitness training!

In a future post, I’ll write more specifically about Earl’s exercises and rehab program. For now, check out these resources on canine fitness and its benefits for senior dogs:

I’ve discovered I have difficulty the non-linear manifestation of Earl’s dementia symptoms. Some days pass as if he has no cognitive decline whatsoever. Other days, he begins pacing in the early afternoon, his anxiety continuing through the evening. And still other days, I notice a new symptom that has never appeared before, and has yet to return.

“The fall into illness, the difficulty of the illness itself, the realisation that something is wrong: these things can be accounted for, if not always easily, but everything that happens after we realize we are ill and seek out help can’t be tied up so neatly.” – Fiona Wright, Small Acts of Disappearance

It’s funny how an Australian writer’s collection of essays on disordered eating has inspired several of my blog posts on dog training. But, as the cliche goes, inspiration comes from unusual places.

I’ve discovered I have difficulty the non-linear manifestation of Earl’s dementia symptoms. Some days pass as if he has no cognitive decline whatsoever. Other days, he begins pacing in the early afternoon, his anxiety continuing through the evening. And still other days, I notice a new symptom that has never appeared before, and has yet to return.

About a week ago, I decided to take Earl for a walk in a new location. After all, mental stimulation and cognitive challenges are supposed to be helpful for senior dogs like Earl. Unfortunately, my idea backfired; he became anxious and confused. He kept wanting to walk in one direction, and one direction only (which happened to be the direction that led away from our home.) I ended up having to carry him back. Heartbreakingly, he was trembling until we reached our familiar walking path. “Great job, dog trainer,” I remember thinking to myself.

It’s so easy to feel a failure when it comes to managing the symptoms of canine cognitive decline.

Of course, Earl quickly resumed his normal behavior once we returned to familiar ground. We’ve even had a few long walks since then without those symptoms. But I find myself remembering how anxious Earl was during that walk, trying to understand why he began feeling that way, and finding myself at a loss at the inconsistency of his symptoms.

Wright’s above quote in Small Acts of Disappearance beautifully summarizes the difficulty of managing a disease after the diagnosis. In the flurry of detecting the problem, educating oneself on the disease, and developing a treatment plan, it’s easy to feel progress. Things appear to move in a linear fashion. It’s only after the diagnosis is given, treatment has started, and the day-by-day life with the disease has begun that the feeling of linear progress disappears. Or, as Wright terms it, “the mundane nature of the process of getting better.”

I still don’t know with certainty why Earl became anxious on our walk last week. And I don’t know whether it will happen again. The same can be said for a myriad of other symptoms that have occurred and might occur in the future. These things can’t be tied up neatly. And it’s a great exercise in mindfulness to be ok with that.

As much as I’d like to think I can single handedly take on oxidation, beta-amyloids, apoptic bodies and all the rest, I can’t. And approaching Earl’s disease, muscles flexed, ready for battle, won’t best serve him or myself.

“A complete reversal of the symptoms of canine cognitive dysfunction is not going to happen with any of the interventions we know about today. There are no miracle cures.” – Eileen Anderson, Remember Me? Loving and Caring for a Dog with Canine Cognitive Dysfunction

The past week has been consumed with organizing Earl’s new regimen of supplements and medication. I’ll go into detail in a future post, but for now, here’s the master list, as prescribed by his veterinarian:

Fluoxetene (which he was already taking prior to his CCD diagnosis)

Melatonin

Denamarin

Seneplex

Neutricks

Trazodone (also prescribed prior to CCD onset)

I didn’t realize I was thinking in terms of symptom reversal until one of my friends checked in with me recently, asking how I was doing. As we texted back and forth, I realized that, despite my best intentions, I had begun using the wrong lens to view CCD.

The process of giving Earl pills, chews and capsules gives me the feeling of “control,” almost similar to a placebo effect. The supplements are meant to alleviate and prevent the progression of CCD symptoms. In the back of my mind, there’s always that small, non-evidence based thought saying “Maybe Earl will be the one to beat it! Maybe we can stop the symptoms and they won’t progress any further!” (While a little denial sometimes helps us get through tough days, believing in the equivalent of neurodegeneration-fighting unicorns isn’t the best way to care for dementia, either.)

Of course, I was reminded both by my friend and by referencing Eileen Anderson’s wonderful book that canine cognitive dysfunction doesn’t work that way. It’s a progressive disease. And while Earl is getting the best possible care, I cannot control the fact that Earl’s brain is changing as he ages. Nor can I control: “reduced brain mass, increased cerebral ventricle size, meningeal calcification, demyelination, glial changes, increased lipofuscin and apoptic bodies, neuroaxona degeneration, reduced numbers of neurons, increased markers of oxidative stress, and accumulation of beta-amyloid” (Gary Landsberg, Therapeutic Options for Cognitive Decline in Senior Pets).

The reason I quote Landsberg is not to make this blog sound pompous, but to ground myself in the facts. Facts help me release the pressure of trying to control what’s happening to Earl’s body. For as much as I’d like to think I can single handedly take on oxidation, beta-amyloids, apoptic bodies and all the rest, I can’t. And approaching Earl’s disease, muscles flexed, ready for battle, won’t best serve him or myself.

My friend reminded me last night to enjoy all the beautiful moments I have with Earl. There will be good days. There will be bad days. (That’s the topic of a future blog post, too.) The neurodegenerative processes will continue. Accepting this fact is a relief, because it helps me let go of the need to control Earl’s CCD, as opposed to accepting it and responding to it with evidence-based care, patience and love.

*Special thanks to the friends who have reached out and been there for me the past couple weeks.

Last year, I wrote a post for Positively.com on a mindful approach to stress management in dogs. The basic premise:

“Imagine a wall of dials.

Each represents a source of stress for your dog, and can be turned high or low, depending on the day. One dial might be your dog’s internal state. Another might be the environment. Yet another might be the availability of positive reinforcers. Yet others might be mental stimulation, physical exercise, and pharmacological interventions. These dials can be specific; if your neighbor is remodeling his house, the noise of jackhammers and construction equipment could certainly be a dial turned on highest volume for your dog (and you). If you live in a thunderstorm-prone area, that dial could turn up or down depending on the day and season.

When too many of the dials are turned up to full volume, your dog may refuse food, display signs of stress and fear, and be unable to learn effectively due to the amount of triggering stimuli coming his way. In dog training, we call this state of being “over threshold.” The goal in any training protocol is to reduce stress so that the dog remains “under threshold.” In other words, the dog remains one hundred percent, no-holds-barred OK in his environment. Under threshold does not mean the dog is mostly fine. Under threshold does not mean the dog is nervous but hanging in there. Under threshold does not mean the dog is triggered but shut down or not reacting. Under threshold means exactly that: the dog is under the threshold at which things start to become uncomfortable and when the sympathetic nervous system kicks in with fight, flight and freeze reactions. Under threshold means no fear.”

When it comes to canine cognitive dysfunction, much of my day-to-day management with Earl fits into this paradigm. While different from training with a fearful dog, Earl’s dementia causes stress. Whether it’s his nighttime pacing, his increased anxiety with different routines and environments, or his confusion, he’s experiencing stress.

Unfortunately, if I set out to make Earl’s environment stress free all the time, I will always fail. Both my husband and I work full-time. While owning my own business allows me some flexibility, I still need to be away from the house to see clients and teach classes. When neither my husband nor I are home, I need to take Earl to daycare (for his separation anxiety). Daycare days are stressful days and exacerbate his symptoms. On days when my husband is home but I am gone all day at work, my long absence exacerbates his symptoms.

I’ve had many moments of isolation and sadness at both my inability to be home 100 percent of the time for Earl and the toll of attempting to pursue life at normal speed while still attending to all Earl’s needs. In short: it’s not possible to keep all of Earl’s “stress dials” on low all the time.

What I can do is manage his environment – his “wall of dials,” in keeping with the metaphor – to keep his stress as low as possible. On days he goes to daycare, I make sure I have puzzle toys and chews at the ready when we come home. Because he paces more often on nights after daycare, I proactively more time in his safe space (in Earl’s case, our bed). I also talk to my veterinarian about his medication regimen to help his body relax.

While not a perfect system, it’s a sustainable way of envisioning and managing Earl’s canine cognitive dysfunction. An all-or-nothing approach will inevitably lead to burnout. And as much as I’d love to put life on hold so the only responsibilities on my schedule each day revolve around Earl, I have bills to pay and a business to maintain.

Living with a dog with canine cognitive dysfunction means continually assessing the wall of dials and adjusting the ones I can so that at any given time, I increase the chances that Earl less stressed and able to to cope with what the environment throws our way.

And it means throwing in some self-care days for both of us when we can: A bubble bath and a good book for me, and a dried duck tendon by the fireplace for Earl.

On recommendation of our veterinarian, I recently started Earl on over-the-counter melatonin to help reduce his pacing and nighttime restlessness.

Melatonin is a neurohormone that is secreted by the pineal gland in the brain. Its primary functions are regulating the body’s sleep and wake cycles – the “internal body clock.” Levels fluctuate according to time of day. They rise by evening, remain high during the night, and drop in the morning.

In dogs, melatonin has been used to treat a variety of conditions, including separation anxiety, noise phobias, and sleep disturbances.

You may remember from my post “Safe Spaces” that one of Earl’s primary cognitive dysfunction symptoms is nighttime restlessness. His ability to nap after periods of sustained enrichment and exercise has decreased, as is his ability to settle from early evening until 9 pm. What used to be a time for napping and the occasional puzzle toy or game has turned into a consistent block of pacing and restlessness.

I started giving Earl melatonin a week ago after discussing dosing with our veterinarian. The goal is to help regulate his sleep-wake cycle, and to promote relaxation in the evening. Thus far, I’ve noticed a slight improvement in his ability to nap and sleep peacefully through the night.

In digging for more research on melatonin in senior dogs, I found some interesting morsels:

According to Dr. Scott Nimmo MRCVS BVMS, “Melatonin has been used to help sleep patterns in pets that are very active at night and not sleeping at the right time. This can sometimes occur in older dogs (sundowner syndrome). Basically it helps re-set the animal’s biological clock.”

“The benefits of keeping records of our dogs’ lives extend well beyond being able to refer to them at vet visits. Humans are notoriously bad at assessing the dates of events (Hammond 2012), and the kinds of gradual changes that are connected to a long-term condition may be the hardest of all to track.” – Eileen Anderson, Remember Me? Loving and Caring for a Dog with Canine Cognitive Dysfunction

Up until now, I’ve relied on memory and (in keeping with my generation) a history of Facebook posts to catalog Earl’s behavior and symptoms. Now that his care is getting ever more complicated with new medications, supplements and behavior changes, I need a better system of recording Earl’s behavior so I can:

Track behavior over time

provide an accurate account to our veterinarian, and

determine the efficacy of various treatments.

I will be adding 3 supplements to Earl’s medication regimen, which makes a total of 6 medications and supplements per day. In order to determine the effectiveness of the new supplements, as well as importance of time of dosage during the day, I need help recording the data.

Because CCD is a confusing diagnosis, with a myriad of confusing symptoms, the more ways I can provide organization and evidence-based methods to my care for Earl, the better. And, the less admin I have to worry about, the more time I have to help Earl stay healthy and stress-free, my main priority.

After researching various online health tracking tools, I downloaded Symple – Symptom Tracker and Health Diary from iTunes. One of the benefits of using an application like this versus traditional pen and paper recording is the ability to easily track symptoms over time. To start, the app asks you to choose 10 symptoms to manage 10 factors to study. The app tracks data from these two inputs over time. It also provides a symptom journal and a section to store photos. Another benefit is the ability to set reminders for consistent recording.

After setting up the application, I’ll continue to share my reviews and progress.

Some other pointers for staying organized amid the chaos of CCD:

Check with your veterinarian about an online pharmacy. In addition to easy medication delivery, you can also set up automatic refills and reminders, taking one less thing off your to-do list.

Record when you start a certain supplements or medications, the time of day, and the dosage. When adding new things, this information is important when talking to your veterinarian about determining whether the treatment is effective or needs adjusting.

Keep a hard copy of your dog’s records available in case of emergency, or in case someone else needs to act on your behalf at the veterinarian. Symple provides a backup functionality so that in case something happens to your phone, you still have your data.

Write down the cost of each medication and supplement, and how you obtain it (online pharmacy, Amazon, Walgreens, etc). This will help reduce the confusion of where to get what product, and provide a reliable price tracker. (For example, I discovered that ordering Neutricks from Amazon Prime is $20 cheaper than ordering through the online pharmacy. Something I want to remember in the future!)

If your cabinets are starting to look like their own mini pharmacy, purchase a weekly pill organizer from your local drugstore to make dosing time less confusing.